Lower back pain

Lower back pain is probably familiar to almost every modern person. Employability can be affected by a wide variety of reasons. Among them are backache, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be inattentive to this, because back pain can not only reach incredible strength, making a person’s life unbearable, but also turn out to be a symptom of the most dangerous diseases.

Lower back pain can be varied: acute or dull, aching or burning, local (appear in one place) or spreading to the entire back. Unpleasant sensations also appear in different ways: sometimes abruptly, suddenly, and sometimes gradually, intensifying every day.

The response to pain and the ability to tolerate it depend on many factors: age, mental characteristics, accompanying symptoms, and other factors. But in any case, you can not leave the disease to chance. Timely treatment will help to avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, computed tomography or magnetic resonance imaging. Attacks of pain, lumbosacral, appear during life, in about 80% of modern residents of European countries.

Acute or chronic back pain in the lumbar region is a consequence of a variety of neurological, degenerative-dystrophic diseases of women and men. In some cases, lower back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and a non-professional will never be able to determine the real source of the problems. In general, the medical classification separates primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is he who is the cause of the vast majority of cases of back pain in the lumbar region. The most significant of the causes is degenerative-dystrophic changes occurring in various parts of the spine:

• osteochondrosis, which is a lesion of bone and cartilage tissues, this disease has a dystrophic character. With it, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
• spondyloarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine, or synovial joints.

Secondary pain syndrome has much more diverse causes of pain:

• scoliosis, which is a curvature of the spine, as well as some other growth diseases;
• various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• a tumor located on the vertebrae, in the spinal cord itself or in the retroperitoneal space, regardless of whether it is primary or caused by metastases;
• fracture of one or more spinal vertebrae. This is perhaps one of the most serious causes of back pain;
• various infectious diseases that lead to damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• stroke conditions in which there is a serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back hurts;
• diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction;
• often back pains are of a reflected nature. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause referred back pain).

Acute and chronic low back pain

Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced lower back pain is also often observed: in this case, there is a translation of pain sensations from more deeply located internal organs and structures of the body; in other words, it seems to the patient that the lower back hurts, but in fact a completely different part of the body is affected.

Most often, the back hurts in the lumbar region, when pain is projected into this area from the pelvic organs, kidneys, pancreas, colon, or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation, what exactly should not be done: to self-medicate. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.

Possible causes of acute low back pain include:

• The pain is accompanied by an acute stretching of the muscles. In this case, pain signals are localized in the back, they are supplied by spasmodic long muscles. The pain does not tend to move to the groin or leg area. Human mobility is limited.
• One of the most common and severe causes of severe back pain is a fracture of the spine (fractures of the vertebrae, including compression ones). As a rule, this happens with an unsuccessful fall, bending of the back and other injuries; but in the event that a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there are cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system, vertebral fractures can occur literally "out of the blue", and even without fixation by sensationspatient at the time of the fracture.
• An equally unpleasant situation in which the lower back hurts sharply is the displacement of the intervertebral discs that has occurred in the vertebral region. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIV and above are rarer cases.

Symptoms include severe lower back pain, forced posture, limited mobility. Participation in the pathological process of the nerve roots is indicated by:

1. radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increase or decrease in the level of sensitivity);
3. decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
4. decrease in intensity or absence of a knee jerk (indicates damage to the L3-L4 area).

The general trend is for a protruding intervertebral disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With the defeat of the cauda equina (horse tail), the functions of the bladder and rectum are disturbed. Also, a similar condition can occur with a strong protrusion of the spinal disc.

The back hurts sharply in the lumbar region with facet syndrome: in this case, the disc remains unaffected, and the pain appears as a result of compression of the root itself at the outlet of the spinal canal. The most commonly observed facet syndrome of the unilateral type in the area of the root L5; arises on the basis of an increase in the facets of the intervertebral joint (upper and lower), and, as a result, narrowing of the intervertebral foramen.

Also, severe lower back pain accompanies an epidural abscess, a serious disease that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine; the pain becomes especially strong with a mechanical effect on the area of \u200b\u200bpathology (pressure, tapping).

If there are signs of spinal cord compression, any highly effective medical measures are recommended, including surgery. Another reason why the lower back hurts can be diseases of the hip joint - primarily coxarthrosis. In this case, pain is characteristic, radiating to the lower part of the lower back, buttocks, and also to the legs to the knees.

Diseases that are characterized by chronic low back pain:

• Deforming spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligamentous apparatus and further bone growth; bone outgrowths press on the roots and narrow the spinal canal. In the case when aching pain in the lower back is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome, which can be caused by narrowing of the spinal canal, should be considered. An examination is necessary, the results of which establish the final diagnosis.
• Ankylosing spondylarthrosis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, by a reduction in chest movements during breathing. There are pulling pains in the lower back; further arises and progresses the curvature of the spine in the thoracic region. An X-ray examination fixes anomalies of the sacroiliac joints: destruction, change in structure, "bamboo" spine. A thorough examination and finding out the reason why the lower back hurts is necessary, since similar symptoms and limited mobility of the lower spine can also cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made by the method of X-ray examination and myelography.
• Osteomyelitis also causes prolonged, aching pain in the lower back. If this disease is suspected, an x-ray of the bone tissue is performed, a skin test with tuberculin and an ESR determination are performed to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci - the causative agents of osteomyelitis.
• Tumors of the spinal cord (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can provoke constant back pain, initially without any accompanying neurological symptoms.

Causes of back pain of an intermittent nature. Many diseases of the internal organs provoke periodic, sharp or pulling pain in the lower back. At the same time, patients do not have a feeling of stiffness in the back area, there is no clear localization of pain, and pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back hurts not constantly, but from time to time, the answer is simple: do not wait until it hurts "as it should", but consult a doctor.

There is a clear influence of the pathology of one or another organ on a certain section of the spine. So, from the pelvic organs, pain radiates to the sacrum, in diseases of the organs lying in the lower part of the abdominal cavity, it radiates to the lower back (segments L3-L5), and in the upper part - to the segments of the upper part of the lumbar zone or the lower part of the chest zone.

Diseases - the causes of lower back pain, and the area of \u200b\u200bpain distribution:

• If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, such intermittent pain can be caused by chronic prostatitis or the development of prostate carcinoma.
• Various kidney diseases provoke pain at the junctions of the ribs and spine.
• Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - pain spreads to the region of the spinal segments T10-L2;
• With ulcerative colitis, diverticulitis, or colon tumors, the lower back hurts;
• If the back hurts in the thoracic / lumbar regions, aortic dissection (dissecting aneurysm) should be ruled out.

Diagnosis for low back pain

For back pain and lumbago, it is recommended to undergo a computer (shows the condition of the bone tissues of the spine) and magnetic resonance (allows you to assess the condition of the soft tissues) tomography and an ultrasound scan of the internal organs.

One method of diagnosis is radiography, which is relatively cheap and can be useful in detecting a range of disorders, from bone fractures to kidney stones. Many of the detected changes only suggest the correct diagnosis, and further studies may be required to confirm it. In addition, some radiological changes may be concomitant findings that are not the cause of pain.

It all starts with a neurological and orthopedic examination by a doctor. During this examination, the neurological status of the patient is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the muscles of the back and gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.

Sometimes, according to the results of an examination by an orthopedist of a patient with a pain symptom against the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:

• radiography of the lumbosacral spine with functional tests;
• CT scan of the lumbosacral spine;
• MRI of the lumbosacral spine.

The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by an annulus fibrosus, consisting of fibrous cartilage and connective tissue. You can read more about this in the article about the anatomy of the human spine and spinal cord.

The thickness of the discs decreases, the vertebral bodies approach each other, reducing the intervertebral foramina and endangering the nerves and vessels located in them (osteochondrosis).

Protrusion of the discs (protrusion of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (herniated disc) most often leads to compression of the nerve roots, causing pain along the compressed nerve (pain that radiates to the leg, arm, back of the head, neck, intercostal spaces independing on the level of nerve compression) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.

Often, a protrusion or herniation of the intervertebral disc is accompanied by muscle pain along the course of the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.

In addition to nerve compression, the stability of the spinal segment may also be impaired. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, an x-ray of the lumbosacral spine with functional tests may be required.

Most often, the nerve bundles that form the sciatic nerve due to their anatomical location suffer from compression of a hernia or protrusion of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and compression of the nerves and spinal cord passing through it. That is why in case of spinal canal stenosis, it is always necessary to carry out a full course of treatment using a whole arsenal of different treatment methods, and in case of ineffectiveness, surgical treatment.

Which doctor should I contact?

With pain in the spine, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Lower back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Lower back pain is combined with various infections, injuries of the limbs. Pain in the lower back with diseases of the heart and lungs is not excluded. This is established by in-depth examination. After the patient is diagnosed, he is usually prescribed drugs that reduce back pain, normalize blood circulation and help restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasms.

Surgical intervention is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, it is restored, and the pain passes with time.

It is best to relax the spine and paravertebral muscles if you sleep on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last too long, because this is fraught with weakening of the paravertebral muscles, which will only exacerbate the problem. Even with severe pain, you should try to maintain at least weak physical activity.

How to relieve back pain

The occurrence of a pain symptom is often due to muscle spasm, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

So, with a strong, unexpected pain in the lower back, it is recommended to take a muscle relaxant tablet, rub the back with a warming anesthetic gel. When using funds, you should strictly follow its instructions.

In cases where an unpleasant symptom is due to the presence of inflammatory diseases of the internal organs, it is recommended not to delay contacting a doctor, if at a particular moment it is impossible to visit a specialist, and the pain is too intense, you can take Pentalgin or No-shpu. The sore spot should not be warmed up with a heating pad, since heat contributes to the spread of the inflammatory process, and, consequently, to the strengthening of the symptoms accompanying it.

Ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have a pronounced anti-inflammatory, mild analgesic and antipyretic effects.

The course of treatment is prescribed taking into account the severity of the pain symptom. Ointment for back pain is used as the main or auxiliary treatment. With pronounced symptoms of osteochondrosis, rubbing the lower back with ointments based on Ketoprofen, a substance with a powerful analgesic effect, is indicated.

The main plus of local preparations is due to their effect not on the whole body as a whole, but on a specific area that needs treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar drugs in the form of tablets.

Exercises for back pain

Gymnastics is considered as an additional method of treatment of diseases of the lower spine. The exercises shown to patients are quite simple and are not accompanied by a special load on the body. For example, the usual hanging on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate lumbago - pain caused by pinching of its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower section, include exercises:

• raising the legs (so that the knee touches the chin);
• "bicycle", performed lying on your back;
• walking on your knees.

Every day it is recommended to give exercises no more than 10-15 minutes, with pronounced pain - to refuse to perform them.